Chinara Dosse loves helping people.
“It’s kind of what I’m known for, always helping out no matter what it is,” she says.
So, when she was offered a position as an oncology patient navigator through the University of Alabama at Birmingham (UAB) Health System’s Patient Care Connect program, it seemed like a perfect fit.
“That was exactly what I have been praying for to do: to have a job that’s purpose-filled,” Dosse says.
Trained lay navigators guide cancer patients 65 and older through the treatment process at 12 community cancer centers in Alabama, Florida, Georgia, Mississippi, and Tennessee.
“With UAB being such a big institution, it’s so easy to fall between the cracks and get left behind,” says Dosse, who helps 40 active patients navigate the health care system. “Especially with the older population, technology is not really their friend. We’re bridging the gap of the areas [where] things just fall apart for some people.”
To identify these areas, navigators conduct distress screenings to understand what aspects of a patient’s life influence their care, such as comorbidities, scheduling, transportation, diet and nutrition, knowledge of treatment, and psychosocial concerns. Navigators work to eliminate these barriers by helping patients find places to stay during treatment, providing gas cards and transportation resources, assisting with insurance copayments, and linking patients to community resources.
“We spent a lot of time focusing on patients’ empowerment and getting patients to understand even for themselves what resources there are, what kind of questions they can ask of their providers, and how to really be an active participant in their health care,” says Gabrielle Rocque, MD, medical director of the UAB Health System’s Cancer Community Network.
A recent observational study published in JAMA Oncology found that the program contributed to lower health care resource utilization and Medicare spending. The study followed 12,428 geriatric patients from 2012 to 2015 and found that total costs declined by nearly $800 per navigated patient, leading to an estimated decline of $19 million annually across the Cancer Community Network. Emergency department visits, hospitalizations, and intensive care unit admissions also decreased.
Rocque says navigators help cut costs by providing extra contact with patients, coordinating care, and facilitating advanced care planning conversations.
“We believe that they’re identifying symptoms earlier and helping patients manage better so that they don’t let things go to the point that they end up in an emergency room,” she says. With this proactive approach, navigators can complement the work of often-overburdened social workers.
Hiring navigators without extensive medical training also is more cost-sustainable. Initially funded by a Health Care Innovation Challenge Grant from the Center for Medicare and Medicaid Innovation, Patient Care Connect is now funded through alternative payment models, although not all participating sites can afford to continue participating.
“I think having a lay individual whose primary focus has not been the clinical pieces really allows them to make sure that we are asking the questions about some of the logistic barriers … that cause stress for patients that they may not bring to the attention of their physician or nurse,” Rocque says.
Such was the case for Willie Scott, 70, who was diagnosed with prostate cancer in 2012. Since then, three oncology patient navigators have supported both him and his wife through radiation treatment and the aftermath.
“A lot of times you might not feel comfortable in asking questions of your doctor or your nurse,” Scott says. “There’s always something the navigator can tell you about different situations that others might have gone through and to reassure you that everything’s still above-board.”
Scott’s first navigator, Rachel, would keep his wife company during his radiation treatments. Since completing treatment, Scott still gets regular calls from his new navigators, reminding him of upcoming doctor’s appointments or advising him on his diet and exercise regimen.
“I can say, truly, that the navigator—having that person there to be there with us going through that treatment, it was uplifting,” Scott says. “It’s a good support system.”
For Dosse and navigators like her, the program has been satisfying.
“We just get them in the right direction. That’s the most satisfying, to put a smile on their face,” she says. “Even if they have nothing going on, they say, ‘Thanks for checking on me.’”